目的 探讨阿加曲班联合氯吡格雷治疗大动脉粥样硬化性脑梗死的临床疗效及对血清炎性因子影响。方法 选取2013年1月—2014年9月天津海滨人民医院神经内科住院的大动脉粥样硬化性脑梗死患者160例, 随机分为对照组和治疗组, 每组80例。对照组在常规治疗的基础上口服硫酸氢氯吡格雷片, 1片/次, 1次/d。治疗组加用阿加曲班注射液, 第1、2天每天用阿加曲班注射液60 mg, 以500 mL生理盐水稀释, 24 h持续静脉滴注;其后5 d每天用阿加曲班注射液10 mg以250 mL 生理盐水稀释, 分早晚2次持续静脉滴注, 每次3 h。治疗组其他治疗同对照组。两组均连续治疗14 d。比较两组的临床疗效, 比较两组患者治疗前, 治疗7、14 d的NIHSS评分和Barthel指数, 同时比较治疗前, 治疗3、7 d时两组肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)的变化。结果 治疗组与对照组总有效率分别为91.25%、77.50%, 两组比较差异有统计学意义(P<0.05)。两组治疗7、14 d时NIHSS评分均较同组治疗前降低, Barthel指数升高, 同组治疗前后差异有统计学意义(P<0.05)。治疗后, 治疗组NIHSS评分低于对照组, Barthel指数高于对照组, 两组比较差异有统计学意义(P<0.05)。治疗3、7 d, 两组患者炎症因子IL-8和TNF-α均较治疗前显著下降, 同组治疗前后差异有统计学意义(P<0.05);治疗后, 治疗组这两个炎症因子均较对照组低, 两组比较差异有统计学意义(P<0.05)。结论 阿加曲班联合氯吡格雷治疗大动脉粥样硬化性脑梗死具有较好的临床疗效, 可降低NIHSS评分和炎症因子TNF-α、IL-8, 同时能提高患者的Barthel指数, 值得临床推广应用。

Objective To investigate the clinical effect of argatroban combined with clopidogrel in the treatment of large artery atherosclerotic cerebral infarction and its effect on serum inflammatory factors. Methods The patients with large artery atherosclerotic cerebral infarction (160 cases) of Tianjin Haibin People's Hospital from January 2013 to September 2014 were randomly divided into treatment and control groups, and each group had 80 cases. The patients in the control group were po administered with Clopidogrel Bisulfate Tablets on the basis of conventional treatment, one tablet/time, once daily. The patients in the treatment group were iv administered with Argatroban Injection (60 mg diluted with 500 mL physiological saline) through 24 h continuous iv pump infusion on the first 2 d. The next 5 d they were treated with Argatroban Injection (20 mg diluted with 250 mL physiological saline), through continuous 3 h iv infusion twice daily in the morning and evening. Other treatments in the treatment group were the same to the control group. The patients in two groups were treated for 14 d. After the treatment, the efficacy was evaluated, and NIHSS score and Barthel index before and 7, 14 d after the treatment in two groups were compared, while before and 3, 7 d after the treatment the changes of IL-8 and TNF-α in two groups were compared. Results The efficacies in the treatment and control groups were 91.25% and 77.50%, respectively, and there were differences between the two groups (P < 0.05). Within 7, 14 d after the treatment, the NIHSS scores of the two groups were significantly lower, and Barthel index were higher than those before the treatment, and the difference was statistically significant in the same group (P < 0.05). After treatment, NIHSS score of the treatment group was lower than that in the control group, and Barthel index was higher than that in the control group, with significant difference between two groups (P < 0.05). Within 3, 7 d after the treatment, IL-8 and TNF-α of the two groups were significantly lower, and the difference was statistically significant in the same group (P < 0.05). After treatment, the two inflammatory factors in the treatment group were lower than those in the control group, and there were differences between the two groups (P < 0.05). Conclusion Argatroban combined with clopidogrel has the good clinical effect in the treatment of large artery atherosclerotic cerebral infarction, and can reduce the NIHSS score and inflammatory factor TNF-α, IL-8. While Argatroban can improve the Barthel index, which is worth clinical promotion.